| NPI | 1578568259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 6109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 32254) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2010-03-24 |